Abstract Myelomeningocele (MMC) is the most severe form of spina bifida arising from failure of neural tube closure in early embryogenesis, leaving neural elements exposed and leading to significant neurological impairment. Spinal deformities such as scoliosis and rigid kyphosis are common and strongly associated with lesion level. This review summarizes evidence on the mechanisms, evaluation, and management of these deformities in MMC. Scoliosis affects over half of MMC patients, with the highest prevalence in thoracic level lesions. Pathogenesis is multifactorial, involving congenital vertebral malformations and neuromuscular imbalance from paralysis, spasticity, and asymmetric innervation. Kyphosis is less prevalent but can be severe and impair sitting balance. Assessment includes detailed neurological and musculoskeletal examination, ambulation classification, contracture evaluation, and inspection for skin breakdown. Imaging with upright radiographs and magnetic resonance imaging is essential for detecting associated anomalies, intraspinal pathology, and guiding surgical planning. Management aims to limit curve progression and optimize function. Observation is appropriate for mild curves, and bracing may be used in moderate curves to support sitting balance. Surgical correction is typically indicated for curves greater than 50° or impairing function and requires an individualized approach. Anterior or combined anterior-posterior spinal fusion remains the standard treatment. Anterior-only fusion has been shown to reduce infection risk. Key operative considerations include infection risk and neurophysiological monitoring to reduce neurological injury risk.
Singh et al. (Fri,) studied this question.
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